If a claimant fails to provide timely notice of a health claim, what is a likely insurer response?

• A. Pay the claim anyway
• B. Delay payment for a specified period
• C. Deny the claim for late notice
• D. Offer a partial settlement

Answer: (C)

Prompt notice of a health claim is a contract condition. The insurer needs timely information to investigate, verify coverage, and coordinate benefits. When notice is late, the insurer has a legitimate basis to deny the claim because the delay hinders proper processing and could prejudice the insurer. So, the most likely response is to deny the claim for late notice. Paying anyway would ignore the contract requirement, delaying payment for a set period isn’t a standard remedy, and offering a partial settlement wouldn’t resolve the issue created by the late notice unless the policy specifically allows an extension or waive prejudice, which isn’t the typical outcome.